Intensive diabetes treatment reduces long-term heart failure risk

medwireNews: Long-term results from the Steno-2 trial show a large reduction in the risk for clinical heart failure (HF) among patients with type 2 diabetes who received intensive risk factor control.

During an average 21.2 years of follow-up, 13% of 80 patients originally assigned to receive intensive therapy were hospitalized with HF, compared with 30% of 80 assigned to standard care, equating to a significant 70% reduction in risk after accounting for age and sex. There was also a 62% reduction in the risk for the combined secondary endpoint of HF hospitalization or cardiovascular disease death.

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“It is unlikely that the risk reductions seen in the Steno-2 study are attributable to one single component of the multifactorial treatment regimen, but rather to the combination of polypharmacy and lifestyle intervention,” write Oluf Pedersen (University of Copenhagen, Denmark) and study co-authors in Diabetologia.

However, the randomized treatment period in Steno-2 began in 1993. Considering the advances in medication since the time of the trial, the researchers stress that “[t]he significant and meaningful risk reductions reported here should be seen as a benefit of intervention against traditional risk factors.”

They say that the more recent launch of glucose-lowering medications with cardioprotective effects “should lead to optimism in the field of diabetes care.”

The randomized phase continued for an average of 7.8 years, after which all 130 patients who were available for follow-up were offered intensive treatment, consisting of target-driven therapy for blood pressure, cholesterol, and blood glucose, as well as treatment with an ACE inhibitor and aspirin. The patients all had microalbuminuria at enrolment, but preserved left ventricular ejection fraction.

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Overall, 20% of the participants developed HF, equivalent to the proportions of patients who developed myocardial infarction or stroke. The team notes that other studies have reported proportionally higher rates of HF than other cardiovascular outcomes among diabetes patients, but points out that “the Steno-2 study had significantly longer follow-up, thus allowing more time for atherosclerosis progression.”

They conclude: “Our results clearly underline the importance of applying an intensive, multifactorial approach to the management of type 2 diabetes.”